Country in Focus
Financial crisis harms respiratory health in Greece heavy industry is not the only cause of air pollution in Greece. In the countryside, fireplaces have always been used for heating. In Athens, residents traditionally used open fires to create a festive mood. However, last winter, the country’s economic crisis took a heavy toll on people’s ability to heat their homes. As a consequence of the severe fiscal measures the government was forced to adopt, the price of petrol and gas for heating increased sharply, leading many Athenians to turn to their fireplaces in a mood of desperation rather than celebration. As a result, the sky over Athens came to resemble London in the early 1950s, as smog and the smell of burning wood became features of daily life. As air pollution increased, so did visits of patients with chronic respiratory problems to hospital emergency units. “The use of fireplaces as a way of heating raised pollution levels both indoors and outdoors, which resulted in an increase in asthma exacerbations”, says Konstantinos Gourgoulianis (Hellenic Thoracic Society and University of Thessaly, Volos, Greece). According to Marianna Zapanti (University of Athens, Athens, Greece), “Smoke that is produced from inappropriate wood burning (eg, coloured or polished woods) contains chemical substances such as ozone, carbon monoxide, and nitric oxides and nitric acid. These substances can cause eye, nose, and lung irritations, resulting in aggravation of existing respiratory difficulties”. An estimated 8% of the Greek population have COPD, 5–10% have asthma, and another 10% have rhinitis, mainly caused by allergic factors. Zapanti estimates that there has been as much as a 300% increase in respiratory allergies in the past 10 years. “One of the most common respiratory diseases in Greece is COPD, which in 50% of cases remains
www.thelancet.com/respiratory Vol 1 September 2013
undiagnosed”, says Panagiotis Behrakis, (Harvard University, Cambridge, MA, USA). According to Behrakis, lung cancer has become more common in the past few years. “Every year 8000 cases are diagnosed and now it seems to be affecting younger people. As a cause of death, it is more common than breast cancer in women and smoking is a major factor.” Smoking is an integral part of daily life for many Greeks, almost 40% of the population smokes, and having a meal or drinking with friends is often associated with having a cigarette. In the past decade, five non-smoking laws were enacted only for each one to be largely ignored by Greeks. The Ministry of Health did intensive inspections at schools, hospitals, airports, restaurants, and bars and confirmed that the smoking ban was violated almost everywhere. Every time a new ban was passed, the federations of bar and restaurant owners protested and in some cases even filed court appeals against the state, claiming that these laws play a major part in decreasing their clientele, although none of these appeals was successful. Gourgoulianis believes that the popularity of smoking has decreased in the past few years; however, Greece still ranks as one of the most nicotine-addicted countries in the EU. Combined with the fact that shrinking incomes have led people
Published Online August 20, 2013 http://dx.doi.org/10.1016/ S2213-2600(13)70147-4 For the WWF report see http:// www.wwf.gr/images/pdfs/ Lignite-Position-Paper.pdf
Will & Deni Mcintyre/Science Photo Library
Smoking, air pollution, and smog: Greece in 2013 has become a hotbed for respiratory illness. The problem is especially bad in Athens, where people are burning anything they can find in fireplaces to avoid paying for highly taxed heating oil, and where many immigrants are crowded into small, poorly ventilated apartments. But most people—whether civilians or members of the government— don’t seem to care. For civilians, the priority is making enough money to support themselves and their families. For the government, it is to make enough money to pay the country’s debt to the European Union and International Monetary Fund. Under these conditions respiratory specialists must face the challenge of restoring lung health to the population of Greece. Nasos Alexiou, a 34 year-old father of three, used to work in a power plant in Ptolemaida, in the northern province of Macedonia. He quit his job because of asthma attacks 2 years ago, after 7 years working at the power plant. “The asthma started gradually and in my last 2 years at the plant it was getting worse. I visited a lung specialist and he suggested it was due to the lignite that was burned in the plant to produce electrical power.” According to a report from the World Wide Fund for Nature (WWF), the Ptolemaida plant is the most polluting power station in Europe. Many people living in Ptolemaida have asthma and chronic obstructive pulmonary disease (COPD); 80% percent of students living in the town will have a respiratory disorder at some point, most commonly laryngitis or rhinitis, according to the WWF report. Alexiou and his family have left Ptolemaida, as have many other residents, since developing respiratory illnesses that threatened to their health. Other cities also show increased prevalence of respiratory disorders resulting from air pollution created by factories. But
511
David Mack/Science Photo Library
Country in Focus
to cut down on their regular visits to doctors, it is easy to see why the general health level of Greeks has suffered in recent years, with the effect on respiratory health being particularly pronounced. “Due to the economic crisis, people do not come in for preventive testing, and medicine used for quitting smoking is not covered by health insurance funds. Also, tuberculosis cases are on the rise because of the massive inflow of immigrants, long working hours, and malnutrition”, says Gourgoulianis. “Pneumonia is also on the increase, with 10% of the patients that need hospitalisation not surviving”, says Theodoros Vasilakopoulos (University of Athens). “Most patients with lung cancer die within a year after being diagnosed”, adds Gourgoulianis,
512
noting that patients with COPD are also usually diagnosed very late. “Most of them die within a few years, after needing repeated admission to intensive care units. Unfortunately, in Greece, primary medical care is underdeveloped, and as a result the cost of admission to hospital is very high. “On average, treatment in a standard hospital room costs about €800 and in intensive care it costs about €3000”, says Gourgoulianis. Similarly, the financial crisis has left its mark on respiratory allergies. “Unemployment, poverty, and unhealthy ways of living all result in the weakening of the immune system”, says Zapanti. “Every day fewer people have insurance and fewer people pay for visits to the doctor. As a result, in many cases patients with respiratory difficulties caused by allergies are diagnosed late.” Despite the challenges faced by Greek hospitals, the quality of treatment for respiratory diseases seems to have increased. “Recently there have been great improvements as far as diagnosis and treatment are concerned”, Behrakis notes. “There is no question that health care in Greece faces a lot of difficulties because of the financial crisis—hospitals lack drugs, equipment, and staff—but Greek doctors seem to meet expectations.” The financial crisis has also affected access to drugs, as the government
tries to cut costs. Households, too, have cut back: about 20% of people are thought to have decreased their health and pharmaceutical expenses. “Patients request cheaper products and reduced time in therapy. Before the financial crisis, 90% of medical costs were covered by social health insurance funds. Now only 75% are covered”, says Vasilakopoulos, noting that the cost of the treatment for quitting smoking is €300 for 3 months and not refundable via social security. In the past few years, some actions have been taken to offer people better information about health. In the respiratory sector, the Hellenic Thoracic Society has run many campaigns and doctors specialising in smoking cessation have formed a special unit that travels across the country and gives respiratory tests to people. But there is still a lot to be done. Behrakis argues that a more direct approach is needed. He believes that it might be time for physicians to take to the streets, go to schools and playgrounds, and knock on house doors, to serve all people, no matter how rich or poor, young or old, with their knowledge and expertise. The respiratory health of all Greeks might depend on such decisive action.
Eva Karamanoli
www.thelancet.com/respiratory Vol 1 September 2013
Financial crisis harms respiratory health in Greece heavy industry is not the only cause of air pollution in Greece. In the countryside, fireplaces have always been used for heating. In Athens, residents traditionally used open fires to create a festive mood. However, last winter, the country’s economic crisis took a heavy toll on people’s ability to heat their homes. As a consequence of the severe fiscal measures the government was forced to adopt, the price of petrol and gas for heating increased sharply, leading many Athenians to turn to their fireplaces in a mood of desperation rather than celebration. As a result, the sky over Athens came to resemble London in the early 1950s, as smog and the smell of burning wood became features of daily life. As air pollution increased, so did visits of patients with chronic respiratory problems to hospital emergency units. “The use of fireplaces as a way of heating raised pollution levels both indoors and outdoors, which resulted in an increase in asthma exacerbations”, says Konstantinos Gourgoulianis (Hellenic Thoracic Society and University of Thessaly, Volos, Greece). According to Marianna Zapanti (University of Athens, Athens, Greece), “Smoke that is produced from inappropriate wood burning (eg, coloured or polished woods) contains chemical substances such as ozone, carbon monoxide, and nitric oxides and nitric acid. These substances can cause eye, nose, and lung irritations, resulting in aggravation of existing respiratory difficulties”. An estimated 8% of the Greek population have COPD, 5–10% have asthma, and another 10% have rhinitis, mainly caused by allergic factors. Zapanti estimates that there has been as much as a 300% increase in respiratory allergies in the past 10 years. “One of the most common respiratory diseases in Greece is COPD, which in 50% of cases remains
www.thelancet.com/respiratory Vol 1 September 2013
undiagnosed”, says Panagiotis Behrakis, (Harvard University, Cambridge, MA, USA). According to Behrakis, lung cancer has become more common in the past few years. “Every year 8000 cases are diagnosed and now it seems to be affecting younger people. As a cause of death, it is more common than breast cancer in women and smoking is a major factor.” Smoking is an integral part of daily life for many Greeks, almost 40% of the population smokes, and having a meal or drinking with friends is often associated with having a cigarette. In the past decade, five non-smoking laws were enacted only for each one to be largely ignored by Greeks. The Ministry of Health did intensive inspections at schools, hospitals, airports, restaurants, and bars and confirmed that the smoking ban was violated almost everywhere. Every time a new ban was passed, the federations of bar and restaurant owners protested and in some cases even filed court appeals against the state, claiming that these laws play a major part in decreasing their clientele, although none of these appeals was successful. Gourgoulianis believes that the popularity of smoking has decreased in the past few years; however, Greece still ranks as one of the most nicotine-addicted countries in the EU. Combined with the fact that shrinking incomes have led people
Published Online August 20, 2013 http://dx.doi.org/10.1016/ S2213-2600(13)70147-4 For the WWF report see http:// www.wwf.gr/images/pdfs/ Lignite-Position-Paper.pdf
Will & Deni Mcintyre/Science Photo Library
Smoking, air pollution, and smog: Greece in 2013 has become a hotbed for respiratory illness. The problem is especially bad in Athens, where people are burning anything they can find in fireplaces to avoid paying for highly taxed heating oil, and where many immigrants are crowded into small, poorly ventilated apartments. But most people—whether civilians or members of the government— don’t seem to care. For civilians, the priority is making enough money to support themselves and their families. For the government, it is to make enough money to pay the country’s debt to the European Union and International Monetary Fund. Under these conditions respiratory specialists must face the challenge of restoring lung health to the population of Greece. Nasos Alexiou, a 34 year-old father of three, used to work in a power plant in Ptolemaida, in the northern province of Macedonia. He quit his job because of asthma attacks 2 years ago, after 7 years working at the power plant. “The asthma started gradually and in my last 2 years at the plant it was getting worse. I visited a lung specialist and he suggested it was due to the lignite that was burned in the plant to produce electrical power.” According to a report from the World Wide Fund for Nature (WWF), the Ptolemaida plant is the most polluting power station in Europe. Many people living in Ptolemaida have asthma and chronic obstructive pulmonary disease (COPD); 80% percent of students living in the town will have a respiratory disorder at some point, most commonly laryngitis or rhinitis, according to the WWF report. Alexiou and his family have left Ptolemaida, as have many other residents, since developing respiratory illnesses that threatened to their health. Other cities also show increased prevalence of respiratory disorders resulting from air pollution created by factories. But
511
David Mack/Science Photo Library
Country in Focus
to cut down on their regular visits to doctors, it is easy to see why the general health level of Greeks has suffered in recent years, with the effect on respiratory health being particularly pronounced. “Due to the economic crisis, people do not come in for preventive testing, and medicine used for quitting smoking is not covered by health insurance funds. Also, tuberculosis cases are on the rise because of the massive inflow of immigrants, long working hours, and malnutrition”, says Gourgoulianis. “Pneumonia is also on the increase, with 10% of the patients that need hospitalisation not surviving”, says Theodoros Vasilakopoulos (University of Athens). “Most patients with lung cancer die within a year after being diagnosed”, adds Gourgoulianis,
512
noting that patients with COPD are also usually diagnosed very late. “Most of them die within a few years, after needing repeated admission to intensive care units. Unfortunately, in Greece, primary medical care is underdeveloped, and as a result the cost of admission to hospital is very high. “On average, treatment in a standard hospital room costs about €800 and in intensive care it costs about €3000”, says Gourgoulianis. Similarly, the financial crisis has left its mark on respiratory allergies. “Unemployment, poverty, and unhealthy ways of living all result in the weakening of the immune system”, says Zapanti. “Every day fewer people have insurance and fewer people pay for visits to the doctor. As a result, in many cases patients with respiratory difficulties caused by allergies are diagnosed late.” Despite the challenges faced by Greek hospitals, the quality of treatment for respiratory diseases seems to have increased. “Recently there have been great improvements as far as diagnosis and treatment are concerned”, Behrakis notes. “There is no question that health care in Greece faces a lot of difficulties because of the financial crisis—hospitals lack drugs, equipment, and staff—but Greek doctors seem to meet expectations.” The financial crisis has also affected access to drugs, as the government
tries to cut costs. Households, too, have cut back: about 20% of people are thought to have decreased their health and pharmaceutical expenses. “Patients request cheaper products and reduced time in therapy. Before the financial crisis, 90% of medical costs were covered by social health insurance funds. Now only 75% are covered”, says Vasilakopoulos, noting that the cost of the treatment for quitting smoking is €300 for 3 months and not refundable via social security. In the past few years, some actions have been taken to offer people better information about health. In the respiratory sector, the Hellenic Thoracic Society has run many campaigns and doctors specialising in smoking cessation have formed a special unit that travels across the country and gives respiratory tests to people. But there is still a lot to be done. Behrakis argues that a more direct approach is needed. He believes that it might be time for physicians to take to the streets, go to schools and playgrounds, and knock on house doors, to serve all people, no matter how rich or poor, young or old, with their knowledge and expertise. The respiratory health of all Greeks might depend on such decisive action.
Eva Karamanoli
www.thelancet.com/respiratory Vol 1 September 2013
